EFFECTS OF SCHROTH EXERCISE ON COBB’S ANGLE, VITAL CAPACITY AND THE IMPROVEMENT OF DAILY ACTIVITIES ON PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS

The aim of this study was to investigate the effects of Schroth exercise on Cobb's angle, vital capacity as well as the improvement of daily activities on patients with idiopathic adolescent scoliosis. Forty patients with idiopathic scoliosis with a Cobb thoracic vertebral angle of 15-30 degrees or higher and the Risser sign stage 3 or higher. The Schroth exercise was applied 3 times a week for 12 weeks. We measured the chest trunk inclination, Cobb angle and vital capacity before and after exercise program. A comprehensive search for all published review articles for spinal deformity was undertaken on PubMed, PEDRO, Google Scholar, Physiopedia up to December 2018. All full-text articles reporting evaluation, validation, surgical, orthotic, and/or physiotherapeutic scoliosis specific exercises (PSSE) treatment outcomes of these spinal deformities were retrieved and analyzed by us and methodology for functional assessment of patients with AIS was developed. Forty patients with idiopathic scoliosis with a Cobb thoracic vertebral angle of 15-30 degrees or higher and the Risser sign stage 3 or higher. The Schroth exercise was applied 3 times a week for 12 weeks. We measured the chest trunk inclination, Cobb angle and vital capacity before and after exercise program. For a period of 12 weeks we accessed adolescents with AIS. All adolescents make Schroth PSSE. The analysis of the results confirms the positive effect of the PSSE to improve muscle endurance, balance and correction of the scoliosis. Within a month from the beginning, patients reported no back pain and within 2 months – a respiratory improvement, an enlargement of the chest, a reduced Cobb angle, an increased vital capacity. PSSE seem to have positive effects by reducing the symptoms and improving functions and body asymmetries. Schroth method is effective of preventing the scoliosis’ progression. The conservative method of treating scoliosis was found to be effective even at a Cobb angle of 35 degrees or higher. In the future, universal methods of approaching exercises and preventive training for the treatment of scoliosis needs to be further developed.

Epidemiological Investigation among Middle School Students in Haicheng City, Liaoning Province

Objective To investigate the incidence and characteristics of scoliosis among middle school students and adolescents in Haicheng City, Liaoning Province, to enrich the epidemiological data of the disease in our city and provide theoretical basis for clinical prevention and treatment. Methods From October 10, 2019 to December 12, 2019, under the organization of the Haicheng Education Bureau of Liaoning Province, students from 37 schools in the city’s junior and senior high schools were screened, and all the subjects were tested in turn. Screening methods, namely the first inspection visual method, Adam bending test, second inspection scoliosis measurement rulers, third inspection standing position spine full length anterolateral X-ray examination. X-ray examination found that Cobb’s angle ≥10° The patient was diagnosed with scoliosis. Results the number of students screened in this screening were 29,314, and the number of confirmed cases was 289 (0.99%). Among the confirmed numbers were 115 males (39.79%) and 174 females (60.21%). The prevalence of females was higher than that of males (X2=27.789). P=0.0000). Among the confirmed cases, 245 cases had Cobb’s angle ≤19°, 28 cases had Cobb’s angle 20°−29°, 10 cases had Cobb’s angle 30° − 39°, and 6 cases had Cobb’s angle ≥40°. Conclusion The incidence of scoliosis among middle school students in Haicheng City, Liaoning Province is higher in the junior high school group than in the high school group. The incidence of female students is higher than that of male students, which should be taken seriouslt.

Intervariability in radiographic parameters and general evaluation of a low-dose fluoroscopic technique in patients with idiopathic scoliosis

Background Radiographic images in adolescent idiopathic scoliosis (AIS) have a potential radiation-induced oncogenic effect; thus lowering radiation dose by using fluoroscopic imaging technique of low-dose fluoroscopic technique (LFT) which might be relevant for clinical evaluation. Purpose To compare radiographs of LFT with gold standard radiographs for AIS ordinary radiographic technique (ORT). Material and Methods Image quality was evaluated for LTF and ORT of a child phantom and two 3D-printed models (3DPSs) of AIS. We measured the primary physical characteristics of noise, contrast, spatial resolution, signal-to-noise ratio, and contrast-to-noise ratio. Three independent evaluators assessed the radiographs by observer-based methods of image criteria (ICS) and visual grading analysis(VGAS). Radiation doses were evaluated by the dose-area-product (DAP) of the 25 phantom radiographs. Reliability and agreement of Cobb’s angle (CA) and other radiographic parameters were evaluated on the 3DPSs and reliability on 342 LFT. Results The average noise and contrast were approximately 15-fold higher for LFT. SNR and CNR were similar. Overall, ICS and VGAS were 3-fold higher for ORT than for LFT for L3 and similar for Th6. Reliability and agreement were good for the experimental LFT, and the interclass correlation coefficient for CA was 0.852 for the clinical LFT. The average DAP and effective dose for LFT were 8-fold lower than those for ORT. Conclusion In conclusion, LFT is reliable for CA measurements and is thus useful for clinical outpatient follow-up evaluation. Even though the image quality is lower for LFT than ORT, the merits are the substantially reduced radiation and a lowered malignancy risk without compromising the measurement of Cobb’s angle, thus following the principles of ALARA.

THE EFFECTS OF DYNAMIC NEUROMUSCULAR STABILITY EXERCISE ON THE SCOLIOSIS AND PAIN CONTROL IN THE YOUTH BASEBALL PLAYERS

While the presence of dynamic neuromuscular stabilization (DNS) has been provided as an important component of the integrated spinal stabilization and associated abdominal stabilization prior to dynamic movement, no previous study has investigated the spinal mechanical effects scoliosis and pain control in youth baseball player with scoliosis. This study compared the effects of gymball exercise, with and without DNS core stability exercise, on spine kinematics and pain control in youth baseball player with scoliosis. A total of 28 participants with scoliosis were randomized into gymball exercise, with and without DNS core stability exercise. Clinical outcomes included the Cobb’s angle and visual analog scale (VAS). Two-way repeated analysis of variance (ANOVA) was conducted at [Formula: see text]. Two-way repeated ANOVA showed that gymball with DNS showed superior effects, compared to gymball without DNS, on Cobb’s angle ([Formula: see text]), but not on VAS ([Formula: see text]). Our results provide novel, promising clinical evidence that DNS improved scoliosis kinematics as well as pain control in youth baseball player with scoliosis.

Reliability of Cobb’s Angle in a Measurement of Kyphosis – A Meta–Analysis

This study aimed at analyzing the literature systematically on the reliability of Cobb’s angle in measurement of kyphosis. Cobb’s angle is the most widely used measurement to quantify spinal deformity. Kyphosis is the spinal disorder in which an excessive outwards of the spine results in an abnormal rounding of the upper back. Cobb’s angle used as standard measurement to determine and trackthe progression of scoliosis andkyphosis. Hence the purpose of the meta-analysis is to analyze the reliability of Cobb’s angle in a measurement of kyphosis Systematic searches in PubMed, Science direct, Google scholar, Cochrane library, Research Gate for systematic review was done. Research article and review article were selected within the published 1999 – 2020. The study design is Meta-analysis study of Analytical type. Study quality was done by PEDro Scale The study duration is about 4 months. A Meta-analysis was conducted by using Medical software to obtain a summary estimate of the standardized mean difference and 95% confidence limit. 100 articles taken for review in which finally 35 articles were summarized. Almost all the study shows that there was a highly significant difference on measurement of kyphosis using COBB’S angle. Outcome of measurement has excellent reliability with the small range of standard error of measurement. Cobb’s measurement had excellent reliability when used to measure kyphosis. The findings confirm the significance and the ease of using this method.

Transthoracic Vertebral Distraction and Stabilization in 10 Dogs with Congenital Thoracic Vertebral Malformations

Objective The aim of this study was to describe the surgical technique and outcomes of dogs with congenital thoracic vertebral body malformations (CTVBM) treated with unilateral vertebral distraction and stabilization with monocortical screws and polymethylmethacrylate (PMMA). Study Design Medical records of 10 client-owned dogs with CTVBM were retrospectively searched for signalment, history, neurological examination, neurological grade based on the modified Frankel scale (MFS), diagnostic method, CTVBM location, Cobb's angle, and vertebral canal angle (VCA), surgical procedure, complications and long-term follow-up. Results One dog suffered cardiac arrest 24 hours post-surgery and died. Median follow-up in nine dogs was 26.5 months (12–50 months). Cobb's angle improved from 33–83 to 10–46 degrees and the VCA ratio from 97–138 to 122–164 degrees. The MFS improved from 3 (n = 3)–4 (n = 7) to 4 (n = 2)–6 (n = 7). Seven dogs recovered full function. Nine dogs improved after surgery compared with preoperative status, recovering ambulation when lost or achieving normal neurological examination in seven cases. No complications were reported during the follow-up period (12–50 months). Conclusion Unilateral transthoracic vertebral distraction and stabilization with monocortical screws and PMMA for treatment of compressive myelopathy due to CTVBM achieved long-term neurological improvement in 9 of 10 dogs.

Prediction of Scoliosis Curve Correction Using Apical Fulcrum Bending Radiographs in Adolescent Idiopathic Scoliosis (AIS)

Background: Scoliosis is defined as a three-dimensional deformity of spine. Surgical treatment is indicated for curves equal to/or more than 40 degrees in magnitude. Curve flexibility is determined preoperatively through bending films, which help in the selection of fusion levels. Surgical treatment for fully-grown spine is a spinal fusion use to inhibit the progress of deformity which further helps in balancing of both sagittal and coronal planes. Therefore, this study aimed to find out the association between predicted via bending films after correction and final surgical correction of skeletally mature patients with Adolescent Idiopathic Scoliosis (AIS). Methods: Thirty-three patients with Adolescent Idiopathic Scoliosis (AIS) were recruited for the study. Those patients were operated at Dr. Ziauddin University Hospital, Karachi from June 2016 to June 2020. Using Pre- and post-operative radiographs of the spine, Cobb values were used to calculate the percentage of correction achieved. Percentage correction (surgical) was then compared to correction possible (predicted) to find association via an independent t-test with p<0.05 considered as statistically significant. Results: Out of total 33 patients, 24 (72.7%) were females and 9 (27.2%) were males. The mean age of the patients was 17.2±3.0 years. Using bending films, correction of the scoliotic deformity was predicted through measured angles with 78±18°. The corrections’ difference was 84.5±11°. This difference was found to be statistically insignificant (p=0.0769) which showed no difference in predicted and actual correction achieved. Conclusion: In skeletally mature patients with AIS, bending films have been shown to accurately predict the amount of postoperative correction of Cobb’s angle which is possible. Keywords: Age Determination by Skeleton; Scoliosis; X-Ray Film; Spinal Curvatures.

Association of Myofascial Pain in Patients with Thoracolumbar Scoliosis, Kyphoscoliosis or Spinal Deformity Attending a Tertiary Care Hospital in Uttar Pradesh, India

BACKGROUND Scoliotic spine puts undue strain on the back musculature which may lead to the production of myofascial pain syndrome (MPS). The purpose of this study was to find out the association of myofascial pain of iliopsoas and quadratus lumborum in scoliotic patients and to look for any correlation between the degree of deformity (Cobb’s angle) and severity of myofascial pain. METHODS A total of 60 patients of low back pain with spinal deformity were enrolled in the study. The severity of the spinal deformity and pain was calculated with Cobb’s angle and visual analogue scale (VAS) pain scale (0 - 100) respectively. Patients with iliopsoas and quadratus myofascial pain underwent trigger point therapy along with regimen of stretching exercises. VAS scores were recorded at 0 - hour, 2 - hour, 2 - weeks, 1 month and 3 months after the procedure. RESULTS Forty-four patients out of 60 had myofascial pain of iliopsoas or quadratus lumborum or both. 15, 31 and 12 patients had Cobb’s angle of 10 - 20, 21 - 30 and 31 - 40 degree, respectively. Trigger point injections were performed in 38 patients. The pre-procedure median VAS score was 70, at 0 hour 45, at 2 hour 40, at 2 weeks 30, at 1 month 30 and at 3 months 30. A significant reduction (P < 0.001) in VAS score was observed till 3 months. CONCLUSIONS The myofascial pain of iliopsoas and quadratus lumborum is an important source of low back pain in patients with scoliosis. There is no correlation between the degree of scoliosis and severity of low back pain. KEYWORDS Scoliosis, Kyphoscoliosis, Thoraco-Lumbar Spinal Deformity, Myofascial Pain, Iliopsoas, Psoas Major, Quadratus Lumborum, Low Back Pain